Atopic dermatitis (AD) and its severity has been inconsistently associated with lower vitamin D levels as multiple other factors that influence vitamin D status were not always assessed. Methods: A case control study involving AD patients and controls ≥18 years old was performed. Exclusion criteria were systemic immunosuppression ≤ 4 weeks prior to recruitment, renal or hepatic impairment, parathyroid diseases and vitamin D or calcium supplementation. Healthy controls were matched for age, gender, ethnicity, Fitzpatrick skin type and body mass index (BMI). Sun exposure, a 3-day, 24-hour dietary recall and serum 25-hydroxyvitamin D were measured. Results: 38 AD patients and 38 controls participated. Majority had Fitzpatrick skin type IV. Vitamin D was lower in AD [15.9(9.9-24.0)ng/ml] than controls [17.3(14.4-27.2)ng/ml], p= 0.028. It was sufficient in 16(42.1%) AD and 15(39.5%) controls, insufficient in 7(18.4%) AD and 22(57.9%) controls and deficient in 15(39.5%) AD compared to 1(2.6%) control. Sun exposure was similar in both groups. AD had significantly higher dietary vitamin D intake [1.5(0.6-3.1) vs 0.6 (0.3-1.0)µg]. AD was an independant risk for vitamin D deficiency with OR 17.52; 95%CI:1.4- 212.7 and vitamin D insufficiency OR 0.26;95%CI:0.07-0.95. Vitamin D levels did not correlate with AD severity. Conclusion: AD is a risk for vitamin D deficiency despite higher dietary intake and similar skin type, BMI and sun exposure as controls.

Merkel cell carcinoma (MCC) is a rare and aggressive malignancy of the skin, with poor clinical outcomes. Typical conditions include a rapidly growing, solitary dome-shaped, violaceous nodule. Several root causes have been identified - sun exposure, age, lighter skin, immunocompromised state, and polyomavirus infection. Wide local excision is the best treatment. The tumour is radiotherapy-responsive. However, the success rate of the treatment with chemotherapy is rather limited. Immunotherapy has shown promising results. Early detection is important to prevent morbidity and mortality. Case Report: In this literature work, we reported on a particular case of MCC, as exhibited by an 84-year-old Chinese woman, and discussed the clinical features and management of MCC. Discussion: We highlighted that MCC cases have a link to the polyomavirus 5. Patients who were identified with the Polyomavirus 5, and underwent immunotherapy, were seen to depict much better prognosis.

Antihistamine is standard chronic spontaneous urticaria (CSU) therapy. Weight gain is a side effect of concern as prolonged high dose therapy is common. We investigated the effects of 12-weeks loratadine therapy on weight, appetite and parameters of metabolic syndrome (MetS). A cohort study was performed involving CSU patients aged ≥18 years. Patients with diseases or on drugs affecting weight or appetite were excluded. CSU was treated according to standard management. Weight, height, waist circumference (WC), body mass index (BMI) and blood pressure (BP), Urticaria Activity Score 7 (UAS7), Dermatology Life Quality Index (DLQI), hunger and satiety questionnaire, fasting blood sugar (FBS) and fasting lipid profile (FLP) were obtained at baseline, week 6 and week 12. Loratadine cumulative dose were determined. Thirteen (33.33 %) males and 26 (66.67 %) females aged 33.00 (12.00) years participated. Median weight was 62.55 (18.30) kg, BMI 24.60 (6.80) kg/m2, 13(33.33%) patients had normal weight, 12 (30.77%) overweight, 11 (28.21%) obese and 3 (7.69%) underweight. Significant weight gain was observed at week 6, 67.56 ± 16.14 kg vs 68.16 ± 16.95 kg, p < 0.05 and 67.56 ± 16.14 kg vs 64.73 ± 14.60 kg, p = 0.04 at week 12. Changes in BMI, WC, BP, FBS and FLP were insignificant. Three patients developed MetS. Hunger and satiety scores were unaffected. Loratadine induced weight gain despite no effects on appetite. Weight should be monitored in patients on long term loratadine therapy.

Introduction: Studies on nutrition among adult AD, a chronic inflammatory skin condition, are lacking. The objective of this cross-sectional study was to investigate the energy, micro and macro nutrient intakes. Methods: Sixty two adult participants defined by the Hanifin-Rajka criteria were included. AD severity was determined using SCORAD index and objective SCORAD. Demographic data and a three-day 24-hour dietary recall were collected and analyzed. Basal metabolic rate (BMR) was estimated using Schofield’s equation. The Energy Intake (EI): BMR ratio was used to identify under reporters (EI:BMR<1.2). To understand food preferences, main food groups consumed, meat (chicken, beef, and pork), seafood (fish, crustaceans, and mollusk), vegetables, fruits, including eggs and milk were examined. To ascertain food avoidance, open ended questions were asked. Results: Significant differences between the severity of AD groups and energy intake, vitamin A, beta carotene, magnesium, and energy intake-basal metabolic rate ratio (EI: BMR) were seen for SCORAD index. Energy intake was significantly lower among severe AD. Vitamin A and magnesium intake was lower among severe AD. Saturated fat intake was higher among mild AD. EI: BMR was inversely correlated with objective SCORAD. Seventy seven percent of participants were under reporters. Almost 10 percent reported avoiding some form of seafood; predominantly form the crustacean or mollusk group. Conclusion: Subjective symptoms, a component of SCORAD index but not objective SCORAD, may have contributed to significant differences seen. Lower energy intake in severe AD was due to reduced dietary intake during flares rather than underreporting.

Objective: To determine the etiologies of tropical acute febrile illness (TAFI) in West Pahang, Malaysia and to investigate morbidity and mortality factors in relation to TAFI. Methods: A multicenter prospective cohort study was conducted between January and June 2016 in six district hospitals throughout the western part of Pahang State in Peninsular Malaysia. A total of 336 patients answered a standardized questionnaire and blood samples were collected for laboratory confirmation of infectious etiology. Descriptive analysis and logistic regression were performed to identify factors associated with TAFI. Results: A total of 336 patients were included. The patients were mainly Malays (70.2%), males (61.3%), aged (44.6±17.4) years, with more than half (58.9%) presenting with gastrointestinal symptoms. The majority were diagnosed with dengue (35.7%) while malaria (4.5%) was the least frequent. The in-hospital mortality due to TAFI was 9.2%. Patients with meliodosis had five times higher mortality [Adjusted OR: 5.002, 95% CI: (1.233, 20.286)]. Patients with comorbidities such as cardiovascular symptoms (P <0.001) and renal replacement therapy initiation (P <0.001) were significantly associated with in-hospital mortality in all TAFI. Conclusions: The etiology of TAFI in the western Pahang includes dengue, leptospirosis, malaria and melioidosis, which carry the highest risk of in-hospital mortality. The presence of cardiovascular symptoms may be used to assess the disease severity in TAFI, but more studies are needed in the future.